Cardiac Rhythm Management, A CardioSource Clinical Community

Trial Summary Minerva Randomized Study

Title: Atrial Antitachycardia Pacing and Managed Ventricular Pacing Reduce the Endpoint Composed by Death, Cardiovascular Hospitalizations, and Permanent Atrial Fibrillation
Year Presented: 2013
Topic(s): Arrhythmias, Cardiac Rhythm Management, Afib, Prevention/Vascular
Summary Posted: 11/18/2013
Writer: Anthony A. Bavry, M.D., M.P.H., F.A.C.C.
Author Disclosure:   CONSULTING FEES/HONORARIA: American College of Cardiology Cardiosource(SIGNIFICANT), Boehringer Ingelheim(MODEST) RESEARCH/RESEARCH GRANTS: Novartis Pharmaceuticals(MODEST), Gilead(SIGNIFICANT), Eli Lilly(MODEST)
Reviewer: Deepak L. Bhatt, M.D., M.P.H., F.A.C.C.
Reviewer Disclosure: CONSULTING FEES/HONORARIA: Elsevier Practice Update Cardiology(MODEST) RESEARCH/RESEARCH GRANTS: Astra Zeneca(SIGNIFICANT), Ethicon(SIGNIFICANT), Eisai(SIGNIFICANT), FlowCo(NONE), Amarin(SIGNIFICANT), Roche(SIGNIFICANT), Sanofi Aventis(SIGNIFICANT), PLx Pharma(NONE), Bristol Myers Squibb(SIGNIFICANT), The Medicines Company(SIGNIFICANT), Takeda(NONE), Medtronic(SIGNIFICANT) OTHER FINANCIAL BENEFIT: Belvoir Publications(SIGNIFICANT), Journal of Invasive Cardiology(SIGNIFICANT), Clinical Cardiology(NONE), WebMD(SIGNIFICANT), Slack Publications/Cardiology Research Foundation(SIGNIFICANT), Medscape Cardiology(NONE), Regado Biosciences(NONE)

Description:

The goal of the trial was to evaluate atrial anti-tachycardia pacing (DDDRP) and managed ventricular pacing (MVP) among patients with bradycardia and previous atrial tachyarrhythmia.

Hypothesis:

DDDRP and MVP will reduce atrial fibrillation occurrence and minimize right ventricular detrimental effects.

Drugs/Procedures Used:

Patients with bradycardia and previous atrial tachyarrhythmia who recently underwent permanent pacemaker placement were randomized to DDDR (n = 385), vs. DDDRP + MVP (n = 383), vs. MVP (n = 398).

Principal Findings:

Overall, 1,166 patients were randomized. The mean age was 74 years, and 50% were women.

The primary outcome occurred in 26.5% of the DDDR control group, 19.8% of the DDDRP + MVP group (p = 0.04 vs. control), and 21.4% of the MVP group (p = 0.12 vs. control).

DDDRP + MVP was associated with a reduction in permanent atrial fibrillation (hazard ratio = 0.39, p = 0.004).

Interpretation:

Among patients with bradycardia and atrial tachyarrhythmia, the pacer mode DDDRP + MVP was superior at reducing composite cardiovascular outcomes compared with standard dual-chamber pacing. This was mainly due to prevention of permanent atrial fibrillation.

Study Design:

Randomized. Parallel.

Primary Endpoints:

  • Death, cardiovascular hospitalization, or permanent atrial fibrillation

Patient Population:

  • Patients with bradycardia and prior atrial tachyarrhythmia

    Number of enrollees: 1,166 patients
    Mean patient age: 74 years
    Percentage female: 50%

References:

Presented by Dr. Giuseppe Boriani at the American Heart Association Scientific Sessions, Dallas, TX, November 18, 2013.

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